Adult CCRN Critical Care Nursing Practice Exam 100 Original
Questions with Answers and Rationales
1. A telemetry patient develops chest pressure and diaphoresis. What is the
priority?
A. Hallway exercise
B. Routine discharge teaching
C. Immediate assessment and the chest-pain pathway
D. Waiting for severe pain
Correct answer: C. Immediate assessment and the chest-pain pathway
Rationale: Acute coronary syndrome can cause pressure and autonomic symptoms.
Prompt ECG and protocol-directed evaluation are needed without waiting for a
particular pain description.
2. Which ECG change in a symptomatic patient needs urgent evaluation?
A. A loose electrode without a usable tracing
B. An unchanged baseline variant
C. New regional ST elevation
D. Normal rate alone
Correct answer: C. New regional ST elevation
Rationale: New ST elevation with compatible symptoms can indicate acute
coronary occlusion. Assess the patient and obtain urgent interpretation rather than
relying on routine observation.
3. A patient with rapid atrial fibrillation becomes hypotensive and confused.
What is appropriate?
A. A meal before reassessment
B. Independent walking
C. Emergency management of an unstable tachyarrhythmia
D. Routine outpatient review
Correct answer: C. Emergency management of an unstable tachyarrhythmia
Rationale: Hemodynamic instability makes this time-critical. Support circulation
and follow the emergency rhythm pathway rather than treating the rate as a routine
finding.
,4. Why does atrial fibrillation increase embolic risk?
A. Every impulse directly damages the brain
B. Atrial stasis can promote thrombus
C. Risk depends only on pulse rate
D. It always ruptures carotid arteries
Correct answer: B. Atrial stasis can promote thrombus
Rationale: Ineffective atrial contraction can allow thrombus formation and
embolization. Anticoagulation decisions depend on individualized stroke and
bleeding risks.
5. A rate-slowing drug recipient has symptomatic bradycardia. What is
appropriate?
A. Give an extra dose
B. Ignore dizziness on telemetry
C. Assess perfusion and promptly review the medication
D. Assume athletic conditioning
Correct answer: C. Assess perfusion and promptly review the medication
Rationale: Symptoms and perfusion determine urgency. Medication effects and
other causes need assessment before further dosing under the applicable plan.
6. Telemetry shows wide-complex tachycardia. What is the first bedside
priority?
A. Print every old strip
B. Assume artifact
C. Offer fluids
D. Check responsiveness, pulse, and stability
Correct answer: D. Check responsiveness, pulse, and stability
Rationale: Management depends on the patient's pulse and hemodynamic status. A
monitor finding requires direct assessment and emergency activation when
indicated.
,7. A patient is pulseless with ventricular fibrillation. What is appropriate?
A. Routine synchronized cardioversion only
B. Oral medication
C. CPR and defibrillation under the arrest algorithm
D. Wait for a scheduled ECG
Correct answer: C. CPR and defibrillation under the arrest algorithm
Rationale: Ventricular fibrillation is a shockable arrest rhythm. Immediate CPR,
defibrillation, and coordinated algorithm-directed treatment are time-critical.
8. What does pacemaker failure to capture mean?
A. Every spike produces a pulse
B. A stimulus is not followed by expected depolarization
C. Every intrinsic beat is sensed correctly
D. The rate is necessarily too fast
Correct answer: B. A stimulus is not followed by expected depolarization
Rationale: A pacing spike alone does not establish capture. Assess perfusion and
device function when the expected electrical response is absent.
9. A paced patient is dizzy with spikes but no subsequent complexes. What is
appropriate?
A. Stop monitoring
B. Urgent assessment of perfusion and capture failure
C. Assume spikes prove effective pacing
D. Encourage walking alone
Correct answer: B. Urgent assessment of perfusion and capture failure
Rationale: Symptomatic lack of capture can impair cardiac output. Electrical spikes
are insufficient evidence of successful pacing, requiring prompt evaluation and
escalation.
, 10. Which pattern suggests pulmonary congestion?
A. Improved exertional tolerance
B. A healed incision
C. Stable weight without symptoms
D. Increasing dyspnea, crackles, and orthopnea
Correct answer: D. Increasing dyspnea, crackles, and orthopnea
Rationale: Pulmonary fluid can impair gas exchange and produce orthopnea.
Respiratory assessment and prescribed treatment are needed rather than
evaluation of peripheral edema alone.
11. Why use consistent daily weights in heart failure?
A. Independently determine every dose
B. Replace symptoms
C. Identify fluid-balance trends
D. Directly measure ejection fraction
Correct answer: C. Identify fluid-balance trends
Rationale: Weight changes may reflect fluid accumulation or loss. Interpret
consistent measurements alongside symptoms, renal function, electrolytes, and the
clinical plan.
12. An ACE-inhibitor recipient develops tongue swelling. What is the priority?
A. Wait for rash
B. Dietary counseling
C. Emergency airway evaluation for angioedema
D. Next dose with food
Correct answer: C. Emergency airway evaluation for angioedema
Rationale: Angioedema may obstruct the airway without a rash. Immediate
assessment and emergency help take precedence over routine medication
administration.
Questions with Answers and Rationales
1. A telemetry patient develops chest pressure and diaphoresis. What is the
priority?
A. Hallway exercise
B. Routine discharge teaching
C. Immediate assessment and the chest-pain pathway
D. Waiting for severe pain
Correct answer: C. Immediate assessment and the chest-pain pathway
Rationale: Acute coronary syndrome can cause pressure and autonomic symptoms.
Prompt ECG and protocol-directed evaluation are needed without waiting for a
particular pain description.
2. Which ECG change in a symptomatic patient needs urgent evaluation?
A. A loose electrode without a usable tracing
B. An unchanged baseline variant
C. New regional ST elevation
D. Normal rate alone
Correct answer: C. New regional ST elevation
Rationale: New ST elevation with compatible symptoms can indicate acute
coronary occlusion. Assess the patient and obtain urgent interpretation rather than
relying on routine observation.
3. A patient with rapid atrial fibrillation becomes hypotensive and confused.
What is appropriate?
A. A meal before reassessment
B. Independent walking
C. Emergency management of an unstable tachyarrhythmia
D. Routine outpatient review
Correct answer: C. Emergency management of an unstable tachyarrhythmia
Rationale: Hemodynamic instability makes this time-critical. Support circulation
and follow the emergency rhythm pathway rather than treating the rate as a routine
finding.
,4. Why does atrial fibrillation increase embolic risk?
A. Every impulse directly damages the brain
B. Atrial stasis can promote thrombus
C. Risk depends only on pulse rate
D. It always ruptures carotid arteries
Correct answer: B. Atrial stasis can promote thrombus
Rationale: Ineffective atrial contraction can allow thrombus formation and
embolization. Anticoagulation decisions depend on individualized stroke and
bleeding risks.
5. A rate-slowing drug recipient has symptomatic bradycardia. What is
appropriate?
A. Give an extra dose
B. Ignore dizziness on telemetry
C. Assess perfusion and promptly review the medication
D. Assume athletic conditioning
Correct answer: C. Assess perfusion and promptly review the medication
Rationale: Symptoms and perfusion determine urgency. Medication effects and
other causes need assessment before further dosing under the applicable plan.
6. Telemetry shows wide-complex tachycardia. What is the first bedside
priority?
A. Print every old strip
B. Assume artifact
C. Offer fluids
D. Check responsiveness, pulse, and stability
Correct answer: D. Check responsiveness, pulse, and stability
Rationale: Management depends on the patient's pulse and hemodynamic status. A
monitor finding requires direct assessment and emergency activation when
indicated.
,7. A patient is pulseless with ventricular fibrillation. What is appropriate?
A. Routine synchronized cardioversion only
B. Oral medication
C. CPR and defibrillation under the arrest algorithm
D. Wait for a scheduled ECG
Correct answer: C. CPR and defibrillation under the arrest algorithm
Rationale: Ventricular fibrillation is a shockable arrest rhythm. Immediate CPR,
defibrillation, and coordinated algorithm-directed treatment are time-critical.
8. What does pacemaker failure to capture mean?
A. Every spike produces a pulse
B. A stimulus is not followed by expected depolarization
C. Every intrinsic beat is sensed correctly
D. The rate is necessarily too fast
Correct answer: B. A stimulus is not followed by expected depolarization
Rationale: A pacing spike alone does not establish capture. Assess perfusion and
device function when the expected electrical response is absent.
9. A paced patient is dizzy with spikes but no subsequent complexes. What is
appropriate?
A. Stop monitoring
B. Urgent assessment of perfusion and capture failure
C. Assume spikes prove effective pacing
D. Encourage walking alone
Correct answer: B. Urgent assessment of perfusion and capture failure
Rationale: Symptomatic lack of capture can impair cardiac output. Electrical spikes
are insufficient evidence of successful pacing, requiring prompt evaluation and
escalation.
, 10. Which pattern suggests pulmonary congestion?
A. Improved exertional tolerance
B. A healed incision
C. Stable weight without symptoms
D. Increasing dyspnea, crackles, and orthopnea
Correct answer: D. Increasing dyspnea, crackles, and orthopnea
Rationale: Pulmonary fluid can impair gas exchange and produce orthopnea.
Respiratory assessment and prescribed treatment are needed rather than
evaluation of peripheral edema alone.
11. Why use consistent daily weights in heart failure?
A. Independently determine every dose
B. Replace symptoms
C. Identify fluid-balance trends
D. Directly measure ejection fraction
Correct answer: C. Identify fluid-balance trends
Rationale: Weight changes may reflect fluid accumulation or loss. Interpret
consistent measurements alongside symptoms, renal function, electrolytes, and the
clinical plan.
12. An ACE-inhibitor recipient develops tongue swelling. What is the priority?
A. Wait for rash
B. Dietary counseling
C. Emergency airway evaluation for angioedema
D. Next dose with food
Correct answer: C. Emergency airway evaluation for angioedema
Rationale: Angioedema may obstruct the airway without a rash. Immediate
assessment and emergency help take precedence over routine medication
administration.
